Connecticut WIC Program Manual

WIC 100-04 SECTION: Administration

SUBJECT: Contracts for Nutritional Assessment POLICY A contract with a competent professional authority (CPA) (not on the staff of the local agency) who is designated by the local agency to determine the nutritional risk status of potential WIC participants shall include, at a minimum, each of the provisions of the “Sample Agreement for Professional Services to the WIC Program”. Additional terms shall be included, as necessary, to describe the following: • How referrals and appointments will be handled.

• If applicable, the amount of, and the manner in which payment shall be made for specified costs.

SAMPLE AGREEMENT FOR PROFESSIONAL SERVICES TO THE WIC PROGRAM

The (Local Agency) and the (Contractor) hereby enter into an agreement subject to the terms and conditions stated herein and/or attached hereto. The contractor agrees to: 1. Inform all potentially eligible women, infants and children, or their parents or caretakers, of the services provided by the WIC Program and how to apply for benefits. 2. Assess and document the nutritional status of each individual who is interested in applying for WIC benefits, using the guidelines delineated in Attachment 1, and the criteria and standards delineated in Attachment 2. Meet applicable Occupational Safety and Health Administration (OSHA) regulations, including needle stick safety rules. 3. Ensure that the nutritional risk determination is performed and documented by a Competent Professional Authority (CPA), as defined in Attachment 1, who shall also verify by his or her signature, that the woman, infant or child was presented in person. 4. Maintain a National Center for Health Statistics (NCHS) pediatric growth chart in each infant’s and child’s medical file and establish procedures to ensure that authorized local agency staff have access to the growth chart and other information that is pertinent to the individual’s nutritional status. 5. Designate an individual to oversee services to WIC eligible clients, and to participate with the Local Agency in the establishment of formal communication and quality assurance systems, to include training and evaluation. Conduct the necessary follow-up activities to ensure the continuity of health care for WIC clients and transmittal of information for the purpose of WIC certification in a timely manner. 6. Ensure that in the performance of this agreement, the contract will not discriminate or permit discrimination against any person or group of persons on the grounds of race, color, national origin, sex or handicap. 7. Allow observation of the nutritional assessment process and access to all pertinent medical files, records and reports by officials of the local agency, the State of Connecticut Department of Public Health and the U.S. Department of Agriculture for the purpose of ensuring that the terms of this agreement are being met. The local agency agrees to provide initial and annual training, and all necessary certification forms, criteria and standards for participation in the WIC Program. Final determination of the client’s eligibility will be completed by a local agency CPA. The local agency shall also be responsible for food package issuance, nutrition education, and referrals. This agreement shall be in effect from __________________to____________________ Signature__________________________

Signature___________________________ Title ______________________________ Title _______________________________ Date ______________________________ Date _______________________________